Glymphatic system dysfunction in epilepsy: mechanisms and clinical evidence

The glymphatic system, a cerebrospinal fluid-based waste clearance pathway, may be impaired in epilepsy due to seizure-induced neuroinflammation and blood-brain barrier disruption, potentially contributing to seizure generation. DTI-ALPS imaging demonstrates reduced glymphatic function in epilepsy patients, with greater impairment correlating with age, disease duration, cognitive decline, and drug resistance.